5 Reasons Why You Need To Process in Music Therapy

I was off listening to a terrific podcast on processing over at the Music Therapy Round Table (and I highly recommend you go over and give them a good, solid listen). Well, I wanted to make a comment, but it turned out to be, like, six paragraphs, so, um, I figured I'd better head back to my own blog home and write it all out here and link it back to the hardworking Round Table folks: Kimberly Sena Moore, Rachel Rambach, Michelle Erfurt, and Matt Logan! 

As Michelle mentioned (either in the Round Table podcast or the Music Therapy Pro podcast), this business of processing (especially in clinical supervision) is kind of my "thing" (which makes it all sound a little...suspect) (but, really, it's not). I mean, if we're going to be honest (and I think we must), this whole blog is about me processing my experiences as a music therapist. 

I'm determined (determined, I say!) to convince the  music therapy world that we need to make processing a regular part of our work routine. And, yes, I'm sure I've probably said all this before, but I'm saying it again. And this time I'm going to try to be more succinct (stop snickering, I can do this). Okay. Here goes:

5 Reasons Why You Need to Process in Music Therapy:   

1. Processing helps you move your work to a deeper level.

Put simply: processing helps you move beyond observation to trying to understand what you’re seeing, experiencing, hearing, noticing in a session. Matt Logan wisely pointed out that a part of processing is looking at the relationships between the therapist, the client(s) and the music. It's so easy to get caught up in “what do I do? What should I do next?” and completely forget to look at what’s there in the session in a deeper way.

 2. It helps you gain a better understanding of what you're doing and why. 

Thinking through your sessions and trying to understand what happened in your sessions helps you get a stronger grip on the ever-present question:

 What is music therapy?

The longer you practice, the more your understanding of the work you do evolves and your answers to that question change and grow more meaningful. Processing asks you to consider: what is the role of music in my work? What is therapy? Who are the people I'm supporting? 

The more deeply you understand your work the better able you are to communicate why a client, a facility, an organization, a state, a country, the world needs music therapy.  

3. We all have feelings about our clients, and it's important to consider their impact on the therapy process. 

You have feelings about your clients, I have feelings about my clients. It's a normal part of therapy called countertransference. It doesn't matter who you work with (infants right on up through elders) and it doesn't matter how long you've been working and it doesn't even matter what approach you use. It's all part of the process. 

And the things is: just because you aren't necessarily having strong feelings or reactions you might think of as being "negative" (sad, angry, frustrated) it doesn't mean that your feelings aren't getting in the way of your clients' growth. Of course, I'm not saying that they are - just inviting your awareness that they have the potential to do so. 

I'll use myself as an example:

When I pause and reflect on the folks who are in my caseload, I notice there are some clients who stick with me all the time, because the work with them is difficult (or because they appeal to me in some particular way), there are some folks who I avoid thinking about, some who I forget about entirely, and some whose sessions I truly enjoy. 

Processing helps me step back and look at the larger picture of what’s happening. Otherwise, I can easily get bogged down in the "session notes version" of things (you know...what happened first, then what happened) and never move beyond it. 

Processing means I start to be curious and ask questions: 

Hm, why do some of my clients appeal to me more than others? Why do some not? What is it about some people that makes me completely forget about them until I see them in a session? Why is a particular client frustrating me so much? What's my role in this? Is s/he reminding me of someone else in my life? Is my complete joy in working with a particular group of clients making it hard for them to explore feelings of anger they may be feeling toward me (whether it's about me or not)? Is my discomfort about a specific topic obvious to my clients to the point that they're they avoiding looking at it to "please" or protect me? 

4. Processing helps you realize that music therapy doesn’t usually happen in one single session 

Well, okay, depending on where you provide services, sometimes it does. In general, though, processing helps you start to put things together (from one session to the next, over a period of time of working with someone, etc.). If you’re someone who tends to use an activity/therapeutic music experience approach, it’s important to think about what’s going on from moment to moment in a session that you might not have thought to look at. A process paper can help you do this and encourages you to ask questions, such as:

What happened? What patterns am I noticing in our sessions?  Then you move on to: What was I hoping to do with this particular person/group? How did it go? What do I think about that? 

5. Processing with a clinical supervisor helps you see your blindspots.

You don’t see your blindspots. That’s why they’re called blindspots. You don’t know what you don’t know! And, like anybody else, you don’t think to ask yourself something you wouldn’t have thought or known to ask yourself.

And that's okay! That's why there's such a thing called professional clinical supervision!  Yaaay!

Processing with a clinical supervisor helps you begin to see things you might not have looked at before. It doesn't mean you're a bad therapist. It just means that having an extra set of eyes and ears (who happen to have more experience) will help you think about things you hadn't thought to think about before. (Shout out to Michelle Erfurt for your great point that you didn’t really look at stuff to the extent you did until you had supervision!)

So, lovely music therapists: What new and unexpected thoughts are you thinking about your clients and about your work? 

Well, what do you know?

I was minding my own business, journaling away last Sunday morning, listening to (yet another excellent episode of) On Being, where Krista Tippett was interviewing Lawrence Krauss, a theoretical physicist. The aspect of their conversation that caught my attention was this comment: 

Mysteries are what it's all about. In fact, not knowing is much more exciting than knowing, right? Because it means there's much more to learn. The search is often much more exciting than the finding. Mysteries are what drive us as human beings. 

He extended the idea by noting:

One of the values of science is to make us uncomfortable. Somehow that's supposed to be a bad thing for many people, being uncomfortable. Being uncomfortable is a good thing because it forces you to reassess your place in the cosmos. And being too comfortable means you've become complacent and you stop thinking. 

As I listened to him I realized something kind of interesting: I think not knowing is what has kept me passionately in this field for so long. 

Think about it a second. 

When we think we know (the answer, what's going on, what someone's problem is, how things should look, who someone should be, and so on and so forth) we are no longer learning, no longer curious. We stop at the surface, and, because we know then we presume there's nothing else to think about or to find out.

When we're new professionals we either think we know or we think we're expected to know most of what there is to know about music therapy. What we often don't realize is that all we know are the very basics- that there's a whole world of knowing we haven't even begun to come in contact with yet!

It took me a lot of years (and a lot of clinical supervision) to finally understand that my real job as a music therapist is to go out there and ask my clients what they need me to know and learn in order to better support them. 

So many times in my younger (pre-clinical supervision) music therapy days I went into sessions knowing what needed to be done to "help" my clients. I didn't ask, I wasn't curious about what was going on or why my clients might need to be or do things the way they were being or doing things. They were disabled. There was a list of things I knew about disabled people. There was a list of ways music was supposed to "help" disabled people. 

So I went in with my music therapy interventions, applied them, and waited for the activities to work. This is what I was taught (or at least this is what I understood of what I was taught). And when my interventions didn't work I was frustrated with my clients and wondered, "what the hell? Why isn't this working? This is what I was told to do!"

Somehow I had inadvertently stepped into the medical model of music therapy: "Here are the symptoms associated with a particular population of people. Liberally apply music therapy activities to alleviate said symptoms and to increase skills. Music is, after all, intrinsically reinforcing. Success." 

In other words, I'd go into sessions with the attitude of "I know what the problem is, and I know the solution." Except that I wasn't having a lot of success.

Finally I got myself some clinical supervision, and I learned about process-oriented, relationally-based music therapy. But when I stopped doing activities and began to use an improvisational approach, I was terrified! I had no idea what to do- ever. I was convinced I'd failed as a music therapist, because I didn't know anything any more! 

Add to that fact that I work in an institution, and institutions are notoriously entrenched in the all-knowing medical and behavioral model of understanding people. Sitting there quietly with someone (because I didn't always know what to do) and singing about what that person was doing or what I thought it might be about (as opposed to gathering everyone in a circle- or trying to- and forcing them to play instruments with hand-over-hand assistance) was an open invitation to criticism and "why are you just sitting there doing nothing, Roia?" 

But I trusted my clinical supervisor who told me "trust the process". 

As time went on, I discovered the joy in finding out who my clients actually were and began to appreciate the opportunity to get to know them in a more authentic and human way. I got more comfortable with the idea of going into a session and not knowing - not knowing what was going to happen, not knowing (yet) the person in front of me, not knowing exactly what music would be needed that day, not knowing if I was hearing my client properly, not knowing if what I offered was going to be accepted or even make sense. 

And that engaged me in the work of becoming and being a music therapist like nothing ever had! I began to understand music therapy from a whole new perspective: 

We are artists, and we are scientists, and art and science are not about knowing. They're about trying something out (an idea, a hypothesis, some direction) and discovering, or messing up, making mistakes, and figuring out better questions to ask. They're about not knowing, about wondering and curiosity, and finding out what we don't realize we don't know. 

That's amazing to me! And waking up every morning with the thought, "I wonder what will happen today with my clients," and being completely curious excited about that, is what drives my passion for music therapy. Even after doing this for 26 years!

To borrow from Lawrence Krauss again:

In fact, what's really beautiful is every time we make a discovery in science, we end up having more questions than answers.

Yes! 

"What's your story?" 2013 Social Media Advocacy Month

It's Social Media Advocacy Month again, and this year we're talking about connections and the stories we share about music therapy. Or, put another way, we might say we're looking at how our stories define us and then help us to connect with each other. 

Whether or not we're aware of it, we're always telling stories. Stories help us describe (among other things) what we do, who we are, what we believe, how we've come to be, who we've come to be. And stories connect (and sometimes disconnect) us to/from ourselves, to/from our history, our families, our friends, our clients, our communities, our cultures. 

For this moment, let's focus on the stories we tell ourselves. Let's consider the stories we choose and use to help us form a professional identity.

The way I understand it, our identity as music therapists is a compilation of the many stories we have about ourselves: as musicians, as people, as therapists, as family members, as community members, as service users, as learners.

In the process we consider our beliefs about music, about therapy, how we define music therapy, what we understand about health/illness, how music fits into health/illness, about our clients, our biases, what it means to help someone else, what is/isn't helpful, what is meaningful, what we embrace, what we avoid. 

And our stories evolve even further as we give thought to how we choose to present our professional selves/stories to our clients, to our places of employment, to supervisors, to potential users of our services, to curious people, to lawmakers, to our larger communities. 

All of these elements start with the stories we tell ourselves. 

To that end, I'd like to share a list of questions I put together a few years ago for a presentation I did for a self-care series at the Kardon Institute for the Arts.  My hope is the questions will help you become more aware of your own stories, how you decide which stories you'd like to share, how you choose to share them, and with whom. 

What does it mean to be a music therapist? 

• Who am I, or who do I think I need to be as a music therapist? How have I constructed my music therapy identity?
• Do I think there's a "right" way or a "wrong" way to tell my stories as a music therapist?
• What does it mean about me if I present myself in the "wrong" way?
• How much does my history/personality/temperament influence who I am as a music therapist?
• How comfortable am I when I feel I have to defend my role as a music therapist? In sessions? At work? In team meetings? What if someone doesn't like my story?
• How comfortable am I with regard to my skills as a musician, my skills as a therapist? And does that level of comfort (of lack thereof) have an impact on my identity as a music therapist? In what way(s), if at all, does this change my story?
• In what ways do my clients’ needs and expectations of me shape who I am as a music therapist? How do we weave our stories together?
• What do I believe makes someone a “good” music therapist? 
• How do my race, culture, gender, sexuality, abilities/disabilities inform who I am as a music therapist?
• How do my beliefs and/or prejudices with regard to race, culture, gender, sexuality, abilities/disabilities impact my work?
• How do I feel/respond when someone outside of my field defines my profession or makes assumptions about music therapy? What happens when someone else tells my story? What if our stories conflict?
• How has my identity as a music therapist changed and evolved as I’ve moved through my 20, 30s, 40s, 50s, etc.? What are the ways in which my story has changed as I've grown through significant life changes (marriage, birth, loss, death, serious illness, natural/human made disasters, etc.)? 
• If I am a music therapist practicing in a culture that is not my culture of origin, how has this affected my identity as a professional?
• How committed am I to a specific identity or role (or story) I play as a music therapist? Am I comfortable expanding my identity/role? Is it okay to change the story? Under what circumstances? 
• How much of and which aspects of our clients' stories are okay for me to hear? And which aspects frighten me or make me uncomfortable? 
• What roles do I unconsciously assign to my clients?
• How do my beliefs about what constitutes music therapy affect the stories I tell about being a music therapist?

 (Copyright 2010 Roia Rafieyan)

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Introduction: Advocacy --> Recognition --> Access

Since 2005, the American Music Therapy Association and the Certification Board for Music Therapists have collaborated on a State Recognition Operational Plan. The primary purpose of this plan is to get music therapy and our MT-BC credential recognized by individual states so that citizens can more easily access our services. The AMTA Government Relations staff and CBMT Regulatory Affairs staff provide guidance and technical support to state task forces throughout the country as they work towards state recognition. To date, their work has resulted in over 35 active state task forces, 2 licensure bills passed in 2011, 1 licensure bill passed in 2012, and an estimated 7 bills being filed in 2013 that seek to create either title protection or a licensure for music therapy. This month, our focus is on YOU and on getting you excited about advocacy.

Celebrating National Psychotherapy Day

It's National Psychotherapy Day today- the first one ever- and I'll be celebrating by heading, just as I do every other week, to my therapist's office. Why? Because I firmly believe getting my own therapy is an important part of my job as a music  therapist. 

Knowing who I am and what kind of emotional baggage I'm carrying around with me helps me be present and attentive to the clients I serve when I show up to provide music therapy.

When my clients do their best to avoid hearing me invite them to look at a belief they're strongly committed to (sometimes even going so far as to literally stick their fingers in their ears), when they fall asleep mid-session because something we're addressing feels way too overwhelming, when they fight mightily against change...I have a pretty good idea of what it's like. I've felt and done the same (okay, maybe I don't actually stick my fingers in my ears or fall asleep in therapy, but I can be pretty darned noisy if I don't want to know something). 

I'll be honest with you: I am uncomfortable recommending any music therapist I know who hasn't spent at least some time looking at his/her own issues in therapy. I mean, what are we communicating to our clients if we think we're above getting our own therapy? If we, essentially, perpetuate the attitude of stigmatization associated with taking care of one's emotional and mental health? 

One of the (many) reasons I loved the HBO show In Treatment was that the writers made sure the therapist, Paul Weston, went (even though he was kicking and screaming the whole way and was more of a pain in his own sessions than any of his clients ever were in theirs)  for his own therapy! 

Psychotherapy for therapists goes beyond the usual nice, self-care sorts of things we tend to talk about in music therapy circles (you know...the whole getting a massage, taking regular vacations, taking a bubble bath and the like). It's an ongoing commitment to self-discovery, a recognition that, yes, we can and do get in our own (as well as our clients') ways, and figuring out how to (much as we may bravely resist) make changes in our perceptions and ideas about our selves, our lives, and our relationships. 

So, good people, with a grateful nod to Ryan Howes (a blogging buddy who shares his insights over at the Psychology Today blogs as well as being a contributing editor at the Psychotherapy Networker), I invite you to consider how you might join in the acknowledgement and celebration of National Psychotherapy Day. 

After all, mental health and self-awareness are most certainly worthy of celebration!

Beautiful and thought-provoking quote

From the transcript of the January 15th, 2012 On Being episode in which Krista Tippett interviewed singer/songwriter/author Roseanne Cash.

Ms. Cash: Sure. You know when I first became a performer, I was so anxious about it and it took me a long time to grow into it, because I thought that being a performer was about getting a lot of attention and I didn't want that much attention. I liked the writer's life. I liked the privacy and the solitude and being inside my own little mind cave. And over time I realized that it's not about the attention, it's about the energy exchange. I'm doing something for them, but they're doing something for me too, you know? And there's no hierarchy really. It's — and some nights that exchange is so beautiful, you know, I can feel my own energy stretching out to the far reaches of the room and theirs coming back. And there's something sublime about it, and also the temporal nature of it that at the end of the night it's over.

Ms. Tippett: Right.

Ms. Cash: It's like a monk's sand painting, it's wiped clean. And so you can't grab it, you know, which is part of the — the mystical beauty of it. You can't repeat it. You know, the next night might be just awful, like, your energy might not expand beyond two feet beyond you and they are not giving you anything and it doesn't work, but you know, that's the way life is.

Ms. Tippett: Yeah, it's that spiritual discipline of knowing impermanence.

Ms. Cash: Knowing impermanence and showing up even though you don't know what's going to happen.

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I love that! 

"...showing up even though you don't know what's going to happen." 

Isn't that gorgeous?

Aside from the fact that it was just...overall, a beautiful conversation about creativity and music and spirituality and how it all melds together, this particular snippet just captured my attention instantly. 


Here's what I loved about it:


First, it is so absolutely descriptive of my daily experience as a more or less psychodynamically-oriented, relationally-focused music therapist. I am not (really, I am NOT), by nature, what one would call a "flexible" human being. However, many years of practicing music therapy using this approach (and taking part in my own therapy, of course) has gotten me to a point where "showing up even though you don't know what's going to happen" has become okay. It's a concept I've grown into and have come to embrace with a comfortableness I would never have imagined for myself. 


Second, I was drawn in by Roseanne Cash's sharing of her struggle, as a musician and as a writer (basically, as an artist), to come to terms with her art- playing, performing, being musically present, which artistic voice to choose, and what all of that means to her. 


Periodically, people will ask me, "Does one have to be a good musician to be a music therapist?" And, until very recently, I've always responded with what my clinical supervisor has said to me, which is: "Well, the more accomplished you are as a musician, the more you have to offer your clients." And that still makes sense to me. 


But, in a recent email conversation with my colleague, Brian Abrams (who just had a terrific article published in the Arts in Psychotherapy journal), I realized that not only do we, as music therapists, benefit greatly from this type of engagement with our experience as artists and musical beings, but, on some level, maybe because of our chosen professions, we actually need to go through that kind of a struggle. 


Put another way, I think a willingness to come to terms with our own sense of what it means to be a musical self and building an identity as musicians and artists enables us to be present to our clients in a more profound, authentic, and meaningful way. 


You might even say it prepares us to  "...show up even though [we] don't know what's going to happen."

Going South!

I know, I  know, where the heck have I been?! 


I'll tell you, it's been busy around here. Mostly, though, I've been preparing to present a five-hour CMTE at the national conference for music therapy in Atlanta next week! I haven't been able to attend a national conference in a few years now (not since 2006 when it was in Kansas City, MO!), so I must shout "hooray" that I'm finally able to go again (meaning, it's within driving distance). 


What will I be talking about (you may well be wondering)? "Developing the Art of Self-Reflection: Exploring the Relationship Between Therapists and Clients" (I mean, how would you recognize me if I didn't have a ridiculously long title?). 


I'm quite excited about it! From what I gather, so far anyway, there will be around ten people there, and that sounds like a very nicely sized group (although I imagine we could work just as well with a few more). I'm planning for a lot of interaction, music-making, and thinking (truly...who wants to sit for five straight hours and listen to me lecture? Well, lucky for you, I can't sit for that long these days). 


Anyway, here's the blurb. If you have any thoughts about the topic, do tell! If you end up coming to the presentation, I'm a fan of feedback!  I'm so looking forward to meeting those of you who are heading down to the conference (especially the lot of you I only know through online adventures). Safe travels!

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Developing the Art of Self-Reflection: 

Exploring the Relationship Between Therapists and Clients

The relationship between therapists and their clients is an intimate one. When we add music, the level of intimacy increases. As with any relationship, as the level of intimacy increases, the levels of resistance, uncertainty, and investment also increase- on both the therapist's part as well as that of the client. One the one hand, we may put up unconscious barriers, preventing a deeper connection with our clients. On the other, we may become so merged as to be in danger of violating important therapeutic boundaries. As such, the music therapy relationship can become difficult to negotiate.

In this interactive workshop we will begin by defining countertransference. Using case examples, we will work toward an understanding of: What is it? Where does it come from? How does it affect therapy? How do we begin to identify and use countertransference in our work with clients?

Participants will then be invited to share some of the difficult aspects from their own work with particular clients that challenge them in some way. Through dialogue, journaling and music-making we will process and explore some of the following questions: What are some of the ways we use to avoid looking more deeply at some of the clinical challenges we face as professional music therapists? What are some of the beliefs and ideas we, consciously or unconsciously, hold about ourselves, about music therapy, about our clients? And how do these ideas and beliefs affect our work and our clients? Why are certain topics so difficult to bring up in sessions- even if we know our clients need us to do so? What is it about the topics? What is it about our beliefs and ideas that makes it scary? What kinds of messages are being communicated by us to our clients when we don't address difficult issues? 

Through these workshop experiences, participants will work toward developing the skill of self-reflection, using a variety of techniques to process thoughts and reactions that emerge in relationship to their clients. 

What do I (think I) know?

Gosh, it's been an absolute age since I posted. Ack! Hopefully you're all wondering what the heck is going on, and asking yourselves, "where in Pete has that girl been!?"


So, here's the scoop: this has been the summer of ailments (and, evidently, I forgot to mark it on my calendar). No, really. It's been a little bit ridiculous. 


Since April, I've caught two colds (I hardly ever get sick), one monster case of allergies that led to never-ending coughing and ended up requiring two asthma inhalers (I don't have asthma), and, just because life wasn't going to be complete without it, I've been limping (very painfully) around for four solid weeks with my backside, hip, thigh, and knee out of whack. 


Honestly! Is this truly necessary? 


I say all this to you, not just to whine and kvetch about it (because, I mean, who would I be without my whining and kvetching?), but because getting around with extreme pain (it's finally starting to settle down somewhat, thank goodness) has forced me into an awareness I've never had before.


I'm ashamed to admit to you how completely ignorant I've been of this fact: There are a lot of people walking around in constant and terrible pain. They're not complaining and carrying on (like I am). They just go about their business and do what they've got to do. In pain. 


It's one thing to get this on an intellectual level (and, of course, I've always understood this on an intellectual level), but that doesn't mean anything. 


Sure, I've seen my dear friend get to a point where she's had to walk around with a cane (and only for very short distances) because she has extremely painful knees. I always known that she's in pain most of the time, but until recently I'd only understood it on a peripheral level. 


Until I experienced what it's like to be absolutely unable to get from point A to point B (forget the fact that moving made me want to scream and/or cry)...I had no clue. 


Do I have a point I'm trying to make here? Well, yes, I think so.


I'm realizing (yet again) how important it is for me to question some of the things (maybe many of the things) I think I "know". Because a lot of the time...I really don't. Often, all I have is some vague idea in my mind about what someone's experience is- whether the person's in pain, has a serious illness, comes from a culture or ideology different from mine, has some sort of a label (whether s/he wants that label or not), is socially ostracized...The list goes on indefinitely, as you can imagine.


I am struck by how limited I am in my understanding of what any of these things actually mean in terms of a person's life and how it affects who the person is and how they relate to other people and to the world.


In short, I am, yet again, astonished by how much I just don't know. And, more to the point, how much I'm not even aware I don't know. And I have to ask myself: as a music therapist, what are the things I think I know? And how willing am I to find out my assumption(s) may be incorrect? 

Journal Prompt #4- Uncertainty

Image by cowbite via FlickrOne of the hardest aspects of being a music therapist, at least for me, has been working to come to terms with the experience of uncertainty as I work with clients. I'm sure this won't come as a surprise to you, because I've written about it a number of times (here, here, and here- to name a few).


I think part of what makes it difficult to sit with the sense of "um, I'm not sure what's going on here" is this mythology we tend to buy into as music therapists (I guess as any kind of therapists, really) that tells us "you must always know what's going on with your clients and have the perfect intervention and/or response to address it."   


Even after doing this for 24 years, there's still a nagging sense of "I should know" in the back of my mind- even though I know (intellectually anyway) that I don't have to know, and even though I'm well aware my clients aren't always ready for me to know (or aren't ready to know for themselves), and even though I realize it's just a matter of sitting with the feeling and trusting the process.  


I understand that some of my uncertainty comes from the fact that I work with people who don't use the usual means of communication or ways of relating to people. Using a process-oriented approach (and not a product-oriented one) also increases the likelihood that I won't always know what's going on in my sessions. 


And, really, I'm okay with all of that. I'm just...very aware (shall we say) of a feeling of "hmm" when I'm faced with a situation and I'm not sure how to proceed. 


So, lovely readers, I invite you to join me in looking at this part of our work as you journal.


-Do you allow for a bit of uncertainty as a part of your music therapy practice? If you do, in what ways? If you don't, why not? 


-How do you approach uncertainty when it comes up in your work as a music therapist? Do you power through it on your own? Do you seek supervision or consultation? What kinds of questions do you ask yourself?


-How do your beliefs about what it means to be a "good music therapist" affect the way you deal with uncertainty? What does it mean about you, about your abilities as a music therapist, about how people might view the field of music therapy to "not know" what to do or how to approach a therapy situation? 


-What if the "perfect" song or intervention isn't coming to you and you're in the middle of a session? 


-What are some of the things you're doing in your music therapy practice that help you avoid the experience of uncertainty? How does that affect the therapy relationship? What might you be communicating to your clients?


I'd love to hear your thoughts about uncertainty (written out, sung, played as a piece of music, acted out as a play, whatever works for you), so please share them freely. 

Journal Prompt #2 (Who are you again?)

Image via WikipediaWow! First, let me thank all of you who were kind enough to join me in this path of self-reflection and exploration! It has been so neat to hear from you and read your thoughts and responses. I've truly been honored that you've taken the time to share your experiences, and I'm excited to hear/read/see more as we progress!


For my part, I have started to make short videos after some of my sessions (particularly with clients who challenge me or about whom I find I have a lot of feelings) in which I share my thoughts and reactions regarding the therapy experience on that particular day and then play a musical improvisation describing what it was like to be in the session.


It has been interesting for me to hear how being with different clients "sounds" (at least from my own musically and verbally expressed point of view). Of course, it's hard not to hear my own issues and musical patterns creeping into the music (oh, yeah, therapy 'til I'm dead, baby). 


I'm sort of wanting to share some of the videos, but I want to be sure I'm not violating any ethical rules and/or regulations in order to do so.

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Meanwhile, it got me to thinking about Journal Prompt #2:


For most of us, during our busy weeks, we see lots of clients. And there are always the people we work with who stay with us and stick in our minds. 

But there are also clients we completely forget until we see them the next week.
And I started to wonder, why?

Who am I forgetting? Do I forget this person/group all the time? Or is there something going on with this particular client/group that I just want to avoid? Or that I don't like dealing with for some reason? 

What is this person triggering within me? Is it something about this person? Or is something going on with me? Why is it this person/group that I forget?

What is it about this person that feels "forgettable" to me? What might the fact that I'm forgetting this person/group be helping me know/learn/wonder about how this person perceive(s) him/herself? 

How does my forgetting this person/group have meaning in the context of this individual/group's life?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

As you can (plainly) see, it was kind of difficult for me to formulate the questions, but, for me anyway, that's part of the process- figuring out better questions to ask myself. If you come up with a better question to ask (or simply find a better way to word the questions I already tried to ask), do tell.


As always, if you feel comfortable sharing, you're welcome to use the comments section to offer your thoughts or (if you blog) post a link to your blog post or You Tube video. Perhaps you might want to play contrasting musical portraits (a Ken Bruscia suggestion) of a client you think of often and a client you tend to forget, and either video or audio tape the improvisations. Or write a song about a client you've forgotten and share it with us. 


I so look forward to your latest installments!

Journal Prompt #1 (The sounds of silence)

Inspired by the very pleasant time I had with the "Joys of Journaling" workshop participants last night (thanks, guys!), I thought it might be cool to dedicate a weekly (or so) (we can always hope) blog post to sharing ideas with you of things you might like to explore and process in some form of journal.


You could do your journaling in the "old fashioned way, with pen and paper and keep it private (which would be glorious). Or you could do it in an alternative (and more public) form (such as in a blog post, a vlog, as a song, a musical improvisation, a piece of artwork, poetry, or in whatever fascinating form you come up with that I haven't even thought of yet).


The way I see it, you'd be welcome (heck, you'd be encouraged!) to share your thoughts through the Comments you leave (just share a link to the web-place you'd like us to visit to check out your thoughts, ideas, insights and artwork). 


So, in honor of this being the very first journal prompt (hence the title: Journal Prompt #1- not a particularly inspired title, I know, but this is about you and your journaling journey and not so much about me and my weird blog post titles), I'll invite you to think about what we worked on last night:


Think about the experience of silence in your sessions:

Have you had a session in which there was silence for a period of time? Either your silence, your client's silence, or a silent group?

Explore what this silence felt like?

If you could have given it a sound, what sort(s) of sound would best express this silence?

How do you usually respond to silence (outside of your work)? Why?

What was it about this silence that evoked the particular response/reaction you experienced?

Ask yourself: if I were to visually describe this silence (or perhaps create a piece of art or movement), perhaps to kinesthetically express this silence, what would it look, sound, and/or feel like?

What are the qualities you'd find yourself exaggerating? And what are the qualities you might have ignored?

If there aren't any silences in your sessions at all, what's that like? And why?

Go for it, my friends! 

The Joys of Journaling

Image via WikipediaI will be conducting a workshop tomorrow evening (that would be on May 5th, or Cinco de Mayo, as it were) on The Joys of Journaling. It's a part of the Kardon Institute for the Arts Self-Care Series down in Philadelphia.


In honor of this event, I dug out my very first diary which I got for Christmas when I was ten years old. (I know, I know, why the heck is a person with a Jewish mother and a Muslim father getting Christmas presents? What can I tell you? We like giving/getting presents in our family, and we like Christmas songs. I mean, what's not to like?)


Anyway, I've been reading some of the things I wrote back when I was a mere 10, and I have to say they are hilariously funny and sort of poignant from my now forty-five year-old perspective. 


It's interesting (okay, and it's a little embarrassing) to re-visit my younger self and to remember what was so important back then that it caused me all manner of angst. 


It's been an absolute delight preparing for this workshop, because it's no longer (ahem) 1976, and the options for journaling have expanded exponentially. I mean, with the advent of technology (let alone the gradual expansion of my no longer all that young mind) there are, literally, no limits to the many fascinating and creative ways we can come up with to record and to explore our thoughts, feelings, reactions, ideas, identities, and general...stuff!


Admittedly, even though I very much enjoy writing (and reading!) blog posts, and I've certainly written my share of songs that started out in journal form, I remain true to my favorite form of journaling: I have a big stack of trusty wire-bound, college-ruled notebooks filled with the scribbling of whatever comfortable fine-tipped ball-point pen was serving me at the time. 


Now, the plan for tomorrow is to try out some journaling exercises, and I'm hoping to work some music-making in there as a part of the self-discovery process as well. I'll be taking along my little Flip camera and my tape recorder (yes, I did just say that- it's a great gadget, and I adore it for writing songs), so we can try out some alternative journal forms. 


I truly love the act of journaling (even though I sometimes actively avoid it for a period of time until I'm ready to jump in there and look at my stuff). The way I see it, journaling is a conversation I have with myself. 


In terms of being a music therapist, it's helped me define who I am, what I think about the work I do, and, most importantly, it's helped me to learn how to pay attention.


Writing in my diary gives me a chance to say things I can't say to my clients, and it helps me think about why I want to say those things in the first place. It gives me a chance to think through sessions that confound me, and it's a wonderful way to explore the things within me that make it hard for me to hear what my clients (and the other patient people in my life) are trying to say. 


I'm wondering if there are others of you out there who find journaling to be helpful in terms of deepening your work as a music (or any other kind of) therapist. I'd love to hear of your experiences. 

Can I get a witness?

Maddeningly, I managed to catch a cold the minute I returned to work. Well, I suppose it has to happen once in a while. As such, I've spent the last two days mostly napping and reading (and, of course, feeling guilty about missing work) (so much for my "perfect music therapist" fantasy) (ahem).


So, while I'm sneezing away here, I figure it's a good a time as any to post an update.


Update #1: The two taboo topics presentations seemed to go fairly well. There was a lot of dialogue, and a couple of people came up to me afterward and told me they had continued the conversation (some from last year) at their workplaces (which is very cool). 


Update #2: I submitted a proposal to do the CMTE (the one I just did at the Mid-Atlantic Regional conference) at the national conference (that would be for the American Music Therapy Association). I changed the title though (just the title). I proposed it as "Developing the Art of Self-Reflection: Exploring the Relationship Between Therapists and Clients". We shall see what happens. 


Update #3: I'm in the process of organizing myself (a task, I admit) so I can put a goodly portion of the work I did on the CMTE into a book (or a monograph of some sort).  Why am I telling you this (you may well be asking)? Because now that I've put it out into the blogosphere, I'll be forced to get on with it and do it! 


Update #4: I had a very touching experience (when I got back to work) with a small group of women who usually react to my absences by being quite challenging and doing a lot of testing and such. This time around, when I showed up on Monday, they all gathered closely around me while I sang "hello" to them. It was so sweet! And...


Update #5: ...the whole session was made even more phenomenal by the fact that their staff person (when approached by a client from another group who wanted to come and sing with us) very beautifully and kindly explained to her, "It's really nice that you want to come and sing, but this is a music therapy group, and Roia is working specifically with the ladies in this group on goals and stuff. She'll be here on Thursday to do the singing group, and you can go join her then." Sproing!!! Somebody shout "amen!" because that was probably one of the most respectful moments I've had in my career as a music therapist! I am so sending her boss a  happy note of "check out what your cool staff person said!"


I think that's pretty much the story so far. It was a good conference, I must say. It was particularly lovely to put some faces to names I know via Twitter and the music therapy list serv. And there were some really excellent and thought-provoking presentations. Another delight was gathering with music therapy colleagues and students to just play music togehter. Of course, staying up way too late probably contributed to my ending up catching a cold, but it was worth it. 

Taboo Topics in Music Therapy- Part II- The handout

Here, as promised, is the handout from the presentation. If you'd like to use it in some way, please do. Just kindly give me credit, eh? 

Taboo Topics in Music Therapy

March 26^th, 2010

Mid-Atlantic Region Music Therapy Conference, Pittsburgh, PA

It’s the stuff we don’t look at and we don’t talk about that gets us into trouble.

Identifying Personal “Taboos”

Part 1

Clues that something may be going on in sessions that needs exploring (some parts of the following list have been taken directly from Pope, Sonne, and Greene’s book What Therapists Don’t Talk About: Understanding Taboos That Hurt Us and Our Clients):

• Avoiding certain topics
• Changes in how you are using the music in your sessions (i.e., using more music than usual, less music than usual, noticing a particular musical pattern, etc.)
• Doing the same thing with every client/group
• Finding yourself bored or unusually tired/drowsy during sessions
• Having a particularly strong reaction to a specific client
• Obsession
• Seeking repeated reassurance from colleagues
• Creating a secret
• Fantasizing or daydreaming about a client
• Increase in physically handling or touching a client
• “Forgetting” the therapy goals
• Feeling extremely uncomfortable with a client
• Feeling embarrassed by your reactions to a particular client

Part 2

In the process of exploring, ask yourself a lot of who/what/why/how/when/where questions, such as the following:

• What’s going on for me in this situation? What is my reaction to this client/group/staff person/situation? What’s going on in my life?
• Why am I reacting in this particular way? To this particular client/group/situation? What’s going on in the session?
• Whose need am I meeting?
• What information do I have/need to try to figure this out?
• Do I have this reaction to all of my clients or is it just with this person?
• How has my use of music with this client changed?
• Has there been an overall change in how I interact with this client?
• Has there been a role reversal (where I feel as if my client is acting more like a therapist than I am)? Why might that be?
• What is different about the way I’m interacting with this client versus how I interact with my other      clients?
• When did my behavior with this client shift? Was there a specific incident that I recall?
• Has a client (or have I) ever done something that put me in a very awkward or uncomfortable position? Have I worried that other people would find out?
• Have I ever tried to justify my behavior with a particular client?
• Have I been avoiding discussing this situation/my feelings with a trusted colleague or clinical supervisor? Or have I only talked about it peripherally or in an “edited” way?
• With whom can I discuss this situation and get some guidance/support?

Part 3

Situations/encounters/issues I’ve had in my experience as a music therapist that I have avoided talking about, feel ashamed about, I’m not sure how to handle, or that have made me very uncomfortable:

1.

2.

3.

Referring back to each of the situations you described above:

When (Situation #1) _______________________________________________happens/happened I feel/felt:  ________________________________________________. This affects/has affected me/my work in the following ways (i.e., made it difficult for me to work with a particular client/group, created an uncomfortable work situation, kept me from doing something I should have done, led me to do something I wouldn’t otherwise have done, or I don’t know if it has affected my work):

Some of the actions I take/have taken to address the situation/encounter/issues are:

a.

b.

c.

When (Situation #2) _______________________________________________happens/happened I feel/felt:  ________________________________________________. This affects/has affected me/my work in the following ways:

Some of the actions I take/have taken to address the situation/encounter/issues are:

a.

b.

c.

When (Situation #3) _______________________________________________happens/happened I feel/felt:  ________________________________________________. This affects/has affected me/my work in the following ways:

Some of the actions I take/have taken to address the situation/encounter/issues are:

a.

b.

c.

Looking at our resistance

Some of the reasons I have had for not talking about the above situations/encounters/issues are (try to be as specific as you can in describing your feelings and beliefs):

a.

b.

c.

Identifying Resources

Here are some people with whom I feel safe enough to discuss these situations/encounters/issues (i.e., a clinical supervisor, a music therapist whose work I admire, a current or former professor, a trusted colleague, a personal therapist, a group of peers, an online community- in all cases, bearing in mind the matter of client confidentiality, other resources, etc.):

a.

b.

c.

---

References, Books, and Articles I’ve Found That Are Helpful or Thought-Provoking

Bridges, N. A. (1998). Teaching psychiatric trainees to respond to sexual and loving feelings: The supervisory challenge. Journal of Psychotherapy Practice and Research. 7, 217-226.

Bright, R. (1996). Grief and powerlessness: Helping people regain control of their lives. London: Jessica Kingsley Publishers.

Corbett, A. (2009). “Words as a second language: The psychotherapeutic challenge of severe intellectual disability” (45-62) in (Cottis, T., Ed.) Intellectual disability, trauma and psychotherapy. New York: Routledge.

*Corey, G, Corey, M. S., & Calllanan, P. (1998). Issues and ethics in the helping professions (5^th Ed.). Pacific Grove, CA: Brooks/Cole Publishing.

Davies, A. & Sloboda, A. (2009). “Turbulence at the boundary” in  Odell-Miller, H. & Richards, E. (Eds.) Supervision of music therapy: A theoretical and practical handbook, in Schaverien, J. (Series Ed.) Supervision in the arts therapies, New York: Routledge. 

*Dileo, C. (2000). Ethical thinking in music therapy. Cherry Hill, NJ: Jeffrey Books.

Dileo, C. (2001). “Ethical issues in supervision” in Forinash, M. (Ed.) Music therapy supervision. Gilsum, NH: Barcelona Publishers.

Foster, N. (2007). ’Why can’t we be friends?’ An exploration of the concept of ‘friendship’ within client-music therapist relationships. British Journal of Music Therapy. 21(1), 12-22.

Gabbard, G. O. & Lester, E. P. (1995). Boundaries and boundary violations in psychoanalysis. New York: Basic Books.

Gabbard, G. O. (1996). Love and hate in the analytic setting. Northvale, NJ: Jason Aronson.

Hunter, M. & Struve, J. (1998). The ethical use of touch in psychotherapy. Thousand Oaks, CA: Sage Publications.

Kim, J. (2009). First love- An idealized object in music therapy. Voices: A World Forum for Music Therapy. Retrieved from http://www.voices.no/mainissues/mi40009000333.php

Koo, M. B. (2001). Erotized transference in the male patient-female therapist dyad. Journal of Psychotherapy Practice and Research. 10, 28-36.

Kottler, J. A. (2003). On being a therapist (3^rd Edition). San Francisco, CA: Jossey-Bass.

Kottler, J. A. & Carlson, J. (2003). Bad therapy: Master therapists share their worst failures. New York, NY: Brunner-Routledge.

Misch, D. (2000). Great expectations: Mistaken beliefs of beginning psychodynamic psychotherapists. American Journal of Psychotherapy. 54(2), 172-203.

Oosthuizen, H. (2009). “Some thoughts on being a white music therapist” Voices: A World Forum for Music Therapy. Retrieved from http://www.voices.no/columnist/coloosthuizen021109.php

*Pope, K. S., Sonne, J. L. , & Holroyd, J. (1993). Sexual feelings in psychotherapy: Explorations for therapists and therapists-in-training. Washington, DC: American Psychological Association.

*Pope, K. S., Sonne, J. L., & Greene, B. (2006). What therapists don’t talk about and why: Understanding taboos that hurt us and our clients. Washington, DC: American Psychological Association.

Richards, E. (2009). “Whose handicap? Issues arising in the supervision of trainee music therapists in their first experience of working with adults with learning disabilities” in  Odell-Miller, H. & Richards, E. (Eds.) Supervision of music therapy: A theoretical and practical handbook, in Schaverien, J. (Series Ed.) Supervision in the arts therapies, New York: Routledge.

Rolvsjord, R. (2006). Whose power of music? A discussion of music and power-relations in music therapy. British Journal of Music Therapy. 20(1), 5-12.

Searles, H. F. (1979). Countertransference and related subjects: Selected papers. Madison, CT: International Universities Press, Inc.

Van der Klift, E. & Kunc, N. (1994). Hell-bent on helping: Benevolence, friendship, and the politics of help. Retrieved 9/23/05 from http://www.normemma.com/arhellbe.htm

Ulman, K. H. (2001).  Unwitting exposure of the therapist: Transferential and countertransferential dilemmas. Journal of Psychotherapy Practice and Research. 10(1), 14-22.

Yalom, I. (1989). Love’s executioner and other tales of psychotherapy. New York, NY: Perennial Classics.

* Books that are particularly useful.

Copyright 2010 Roia Rafieyan